Let SCHIPs Chart Their Own Course

Why is the federal government paying for children's health insurance?

As "a conservative who wants to help restore the limited federal government envisioned in the Constitution," Rep. Roscoe Bartlett said, he could not in good conscience vote to override President Bush's veto of a bill boosting federal spending on children's health insurance. But the Maryland Republican also said he was "proud" to have supported the creation of the State Children's Health Insurance Program (SCHIP) and promised he would "work to ensure a safety net of health insurance for the children of the working poor."

The Framers would have insisted on nothing less, as reflected in the Constitution's Health Care Clause. Oh, wait. The Constitution has no Health Care Clause. Nor does it include any other provision that authorizes Congress to spend taxpayers' money on health insurance for the children of the working poor, the grandparents of the middle class, the nephews of the super-rich, or the kin of any other socioeconomic group.

Still, Bartlett and Bush deserve some credit for resisting the expansion of a highly popular program that never should have been created to begin with, especially since they knew they'd be accused of being stingy child haters. They would deserve more credit if they applied their avowed principles a little more consistently, in which case the charges of cruel penny-pinching would be less credible.

When Bush vetoed the SCHIP bill, which would have spent an additional $35 billion over five years, he expressed concern about "federalizing" health care. "I believe in private medicine," he said, "not the federal government running the health care system." He also worried that opening SCHIP to families earning up to three times the poverty level (about $62,000 for a family of four) would move it away from its original goal of serving people too poor to afford insurance but not quite poor enough to qualify for Medicaid.

It's hard to reconcile Bush's opposition to a bigger federal role in health care and his emphasis on strict means testing with the Medicare prescription drug benefit he championed, which is expected to cost $675 billion during the next decade while compelling middle-class taxpayers to buy Lipitor for retired billionaires. More generally, Bush's "compassionate conservatism," if it means anything, means a willingness to spend other people's money on sympathetic causes.

No wonder Sen. Orrin Hatch (R-Utah) found Bush's SCHIP veto puzzling. "If we're truly compassionate, it seems to me, we'd want to endorse this program," Hatch said. "I don't think the president is somebody who doesn't want these kids to be covered."

If you're "truly compassionate," according to this prominent conservative Republican, you support more money for SCHIP. Otherwise, you want kids to die of untreated diseases.

The basic question of whether the government should force taxpayers to pay for children's health insurance has not come up much in the debate provoked by Bush's SCHIP veto. But there clearly is wide disagreement about the program's details, including eligibility criteria, coverage of adults, and minimum benefits.

The intractability of these disputes is illustrated by divergent responses to the Congressional Budget Office's estimate that between a quarter and a half of children covered by SCHIP would otherwise have private insurance. For supporters of "single payer" health care, this substitution of government for private coverage, which would become more common if eligibility criteria were loosened, is a feature, not a bug.

Instead of trying to resolve such issues at the national level, why not let each state go its own way, with results that vary depending on local values, the local cost of living, and the local health care situation? No federal money would mean that one state's legislators could no longer force another state's taxpayers to subsidize their generous impulses, but it would also mean no federal restrictions.

Permitting a wide range of policy experiments in areas where the federal government has no license to act is not just the law. It's a good idea.

© Copyright 2007 by Creators Syndicate Inc.

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  • robc||

    Can someone give the kid in the picture some courses in basic logic and civics?

  • ||

    The basic question of whether the government should force taxpayers to pay for children's health insurance has not come up much in the debate provoked by Bush's SCHIP veto.

    That's because there's little to debate - any decent person would agree that government should provide health coverage to children, especially if their families cannot provide it. Despite what the slaveowning elist "Founders" might have thought about it 200 years ago.

  • ||

    er..elitist

  • dbust1||

    I really question whether there was even a concept of "healthcare" 218 years ago. It's not even remotely witty to point out that there are no references in the Constitution concerning gov. provided healthcare. Are there references in the Constitution concerning lunar property rights?

    We have a moral obligation to provide the absolute best care possible to CHILDREN whose parents CANNOT afford healthcare. Providing healthcare to "children" up to age 25 whose parents live well above the poverty line is ludicrous. The changes to SCHIP were designed to bring us one step closer to universal healthcare. By providing care to families that could afford private insurance "the powers that be" could stand up and declare universal healthcare possible.

  • ||

    Though I agree that a federal program for this may not be the best answer, If I had to choose one or the other, having my tax dollars go to pay Blackwater security salaries in Iraq, or for children's healthcare, I would choose the latter, even though, as a libertarian, I am opposed to both.

  • ||

    any decent person would agree that government should provide health coverage to children

    I guess that makes me indecent.

    especially if their families cannot provide it

    I'm guessing the balance sheets of non-profit charitable organizations with missions to provide healthcare to the poor is in the hundreds of billions in the US. I'm not convinced they can't do the job.

  • ||

    I lean libertarian in many respects, but can't agree with this position on healthcare. Even the staunchest Libers still advocate government-provided police and military forces, and I have to ask this question: if its OK for the government to protect us from each other and foreign incursion, why is it not OK for the government to protect us from much more pervasive threats to our health and safety - such as disease and accident? Why wouldn't this fall under that minimal "protective" role alloted to an ideal Libertarian government?

  • ||

    We have a moral obligation to provide the absolute best care possible to CHILDREN whose parents CANNOT afford healthcare.

    Even assuming this is true, it is quite a leap to say that we should meet our moral obligations via state programs. You want to be very careful heading down that road. You might not like the company.

  • ||

    why is it not OK for the government to protect us from much more pervasive threats to our health and safety - such as disease and accident?

    Because police and the army exist to protect us from force and the threat of force, not from the ordinary vicissitudes of life.

  • ||

    The Constitution clearly allows for an expansion of the SCHIP program in the Preamble to the Constitution which reads:

    We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

    Clearly, where the private sector has not and cannot find a way to provide health care for millions of American children, it is entirely appropriate for the government to "promote the general welfare" and assure the proper care for such children.

    On the matter of letting the States operate the SCHIP program and determine priorities for the children of each state, that is exactly what the SCHUP program does. The program varies state by state as decided by each state.

  • ||

    I would argue that the preamble to the constitution is just that - a preamble. It gives insight into the reasons why the document was written, but it is not the document itself. It says it right there... "in order to do x, we've created the following..."

    Also, protecting us from outside threats is a completely different issue than protecting us from sickness... especially when my neighbor seems to be doing everything he possibly can to give himself an early heart attack.

  • ||

    Besides that, as a single person making enough to get by and a little extra for savings but not much, I resent having to shoulder the burden for someone else's kids (read: choice), especially when they make 62K a year.

  • Chuck||

    Ian McLean--

    It is equally appropriate for the government to promote the general welfare by giving everyone $5,000 each. And a pony.

    Make it $10,000. That would promote a lot more general welfare, I think.

  • ||

    Wow, this thread is so poisoned by ignorance, I don't even know where to start...

  • ||

    You are correct. If the government determines that each person should be given $5,000 and a pony in order to promote the general welfare, the Preamble to the Constitution says that is entirely appropriate.

    As it happens, however, that issue is not before us. The issue before us is the fact that millions of American children have no health care coverage.

    You can oppose providing health care to such children, but you cannot argue that the Constitution does allow us provide such care. Providing such care does promote the general welfare which is one of the reasons we the people created the Constitution.

  • Daldude||

    R C,

    This distinction of "force" seems kind of arbitrary and slippery. There are many types of crime that don't involve direct physical force (fraud, embezzlement, shoplifting, etc.), and if you expand the definition of force to include financial misdeeds, then one could argue that extreme economic disparity is itself a kind of force (to paraphrase Gandhi, "Poverty is the worst form of violence"). And is this protection from "force and threat of force" excusive to that of human origin? Wouldn't something like a incursion of killer bees or feral packs of dogs or a massive epidemic also fall under the aegis of a Libertarian government?

  • ||

    dpottsy --

    Your post implies that the Preamble is not part of the Constitution. It is part of the Constitution and it clearly calls on the government to "promote the general welfare."

    Clearly, making sure that the nation's children have proper health care promotes the general welfare. It's so simple.

  • ||

    WHY MEDICAL PRICES ARE HIGH - THE BIG
    THREE THUGS OF MEDICINE

    There's plenty of computer programs that can out-diagnose a physician with an appropriate yes-no series of elimination questions that can zero in on the cause of a likely medical problem. An internet search may achieve similar results.

    There's plenty of health care professionals that could provide much valuable service for lower prices to those who cannot afford to see licensed physicians.

    There's plenty of foreign medical students or licensed physicians who are barred from entering medical school or practicing in the U.S., in order to prevent competition and create a shortage to keep prices high.

    In selected cases, one can get comparable quality surgery in India for 10% of the price in the U.S. as demonstrated in a documentary comparing a $200,000 procedure to one for $20,000.

    There's billions of prescription drugs available for pennies on the dollar to wholesalers, retailers, pharmacy benefit managers and insurance companies - but not to individuals or groups of individual consumers, nor to the government.

    There's thousands of individuals who know exactly what they need, for example, a particular blood pressure medicine perhaps available at Walmart for $4/month, but can't get past the prohibitive up-front fees for a doctor's visit to get a prescription.

    Thanks to Big Pharma, Big Insurance and Big Medicine, access to these possibilities are systematically blocked with market power in the form of restricted access, price discrimination and patent abuse designed to suppress competition everywhere. Much of the regulation is also designed to protect the Big Three instead of consumers.

    Issues like SCHIP always get cast as big government versus private enterprise. But the
    Big Three get most of their money from government either way - they just get more in the phony "privatized" version that injects them and their absurd overhead charges between consumers and medical care.

    One reason studies of universal health care generally show subtantially lower cost than the alternatives is because all the alternatives are loaded up with overpriced everything - from doctors fees to procedures to drugs to hospitals - which are spread across more users to reduce unit cost.

    Rarely are these prices challenged. The result, for example, is some doctors working two days a week to make millions a year. And if qualified competitors started hanging out their shingles there'd be a firestorm to shut them down.

    Today, for example, there could be thousands of physicians available for verifiable, qualified services over the internet in conjunction with a variety of supplemental visual and testing aids to millions of individuals in need. But instead, they do without altogether, thanks to the Big Three Thugs of medical care.

  • robc||

    Ian,

    Article I, Section 8 lists the constitutional means the legislative branch may take to "promote the general welfare". The preamble and the first line of the section are general statements saying what should be done, the detail lines say how.

    Anything outside the detail of Section 8 isnt granted to the Feds.

  • robc||

    For those who dont take my word for it, here it is straight from the authors mouth.

  • SIV||

    But Wait! There is an upper middle class family in Baltimore, the Frosts, who voluntarily chose not to provide their children with health insurance! Thankfully, the US Government stepped in and provided that insurance.What about the other upper middle class families who are burdened with actually paying for their children's insurance? Who will help them?

  • ||

    robc,

    You said that Article 1, Section 8 restricts Congress from expanding the SCHIP program, but that is not the case. Article 1, Section 8 provides:

    Section 8: The Congress shall have power
    to lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defense and general welfare of the United States; but all duties, imposts and excises shall be uniform throughout the United States;

    I sure you notice the words "provide for the ... general welfare" right up front.

    Do you have a different version of the Constitution? Really!!

  • ||

    Hey SIV
    The Frost family is i no way upper middle class. The father is self-employed and is unable to insure himself or his family because of the prohibitive cost of doing so. His income various year to year based on work he can perform.

    Also for all you Constitutional wankers out there it is a piece of paper written over 200 years ago - it is not sacred nor is it perfect. The constitution is a flawed document written by flawed people (as if there are any other kind) to treat it otherwise is retreat world into the irrational world of belief.

  • Tom A||

    Here is a link to the Krugman column about the conservative effort to slime the Family Frost. Let us hear no more about the right-wing misinformation.

    A disussion using truth-based information is more interesting, IMHO.

  • ||

    Also for all you Constitutional wankers out there it is a piece of paper written over 200 years ago - it is not sacred nor is it perfect. The constitution is a flawed document written by flawed people (as if there are any other kind) to treat it otherwise is retreat world into the irrational world of belief.



    Does that argument work elsewhere?

    "Officer, the speed limit laws were written 30 years ago by flawed people. They're just pieces of paper! To act like they're some sort of sacred thing we're bound to and enforce them is just irrational!"

  • ||

    No wonder Sen. Orrin Hatch (R-Utah) found Bush's SCHIP veto puzzling. "If we're truly compassionate, it seems to me, we'd want to endorse this program," Hatch said. "I don't think the president is somebody who doesn't want these kids to be covered."

    ... says the Senator from the state full of Mormons who hate cigarettes and who have lots of children. Perhaps in his dictionary, "compassion" is defined as "political expediency". Hatch's vote was all about bringing home the pork.

  • SIV||

    Where did those Democrats Tom and Kevin come from? I figured mentioning welfare chislers like the Frosts would smoke 'em out.

    Libertarian arguments aside, even a State Socialist government has no business establishing a transfer/entitlement from the poor to the well off.

  • ||

    SIV,

    Well, at least you don't try to hide behind an argument that the Constitution doesn't allow for an expansion of the SCHIP program. You are right out front saying that kids should not be afforded health care -- even those (like the Frost boy) who are prevented from getting health insurance because the insurance industry will not insure those with pre-existing conditions. The family was denied health insurance for the boy at every turn becuase he had "pre-existing" conditions.

    Unable to get insurance for the boy, the family sought and received care through the SCHIP program.

  • ||

    "general welfare" implies a schip program?!....wow what a logical leap...anyway the general welfare clause meant "general welfare" as defined by Constitutional limits...which again gives no enumerated power to create schip in the first place....nice try

  • ||

    kevin...

    so does your all things flawed argument apply to welfare statism?...why isn't that flawed? by your very own logic...try again

  • Jason Ball||

    Funny - congress passed laws throughout the lifespan of the founders and there certainly was not a collective uproar from the revolutionaries that the constitution should be the only law of the land. I don't remember reading anything in the Federalist Papers of our representatives not being allowed to make laws regarding the desires of those whom they represent (unless of course they conflict directly with the constitution). The constitution of course exists to prevent congress from passing laws limiting very specific freedoms without an overwelming demonstrated public concensus. The constitution sets the boundaries of the branches of government and gives the citizenry the (theoretical at least) ability to control the government - the tools are there for their POLITICAL use primarily - the founders did not give us these tools to tell us "but you can't pass laws about things we didn't mention here." The entire idea behind the constitution is to set provide the people with the power and ability to use government to meet the changing needs of society. It allows for the passage of an infinite amount of laws so long as they don't conflict with ground covered by the constitution. Going on about enumerated power is ridiculous for this reason, but it's also ridiculous for another reason: we are lucky to have a legal system which protects our rights (though in practice this is not always the case) and part of our rights are to collectively decide what WE - the living - want. We do this through government and I believe a majority of us would like to pay small amounts every year in order to pay for health care. Stop making the case that "big brother" is forcing this down our throats or that a group of people 300 years ago wouldn't like it.

    Again, most of us are glad to put money into a pot that is used for the public benefit. Most of us aren't glad that our money gets used to subsidize already wealthy private industry and for other assorted pork.

  • ||

    Again, most of us are glad to put money into a pot that is...used to subsidize already wealthy private industry and for other assorted pork.


    Fixed that for you.

  • ||

    Ian Writes: "sure you notice the words "provide for the ... general welfare" right up front."

    I am sure that you notice the word that is absent, people.

    The congress is to promote the general welfare of the states not the people of the states, and yes there is a difference.

    All of the text following the "general welfare" statement detail how the congress is to promote the general welfare (of the states), such as interstate commerce. The best pretext you leftists have is really the commerce clause but even that doesn't really apply here.

    In an earlier post you stated that the congress could legally provide ponies or payments to "promote the general welfare."

    If that is truly your position on Article I, Section 8 then that article says and means nothing because by your definition it could mean anything, which is demonstrably untrue.

    If the text of the constitution proper doesn't convince you that your argument is false, then I leave you with Amendment number 10 - "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved for the States respectively, or to the people"

    This is a state issue and we the people should hold congress accountable and return control to our state legislatures, where it properly belongs.

    this power is not specifically granted to the US congress and is therefore prohibited.

  • ||

    To respond to Mr. Ball's fatuous 300 year old dead man argument:

    If there is a portion of the constitution that is not applicable there is a mechanism provided by the 300 year old dead guys called the amendment process.

    This is a perfectly workable solution as it has been exercised some 27 times (counting the original bill of rights).

    Put your trust and faith in that gang of thieves and liars if you wish, I would prefer to hold them accountable.

  • ||

    Even the staunchest Libers still advocate government-provided police and military forces...

    Sounds like you haven't met the staunchest libertarians then.... Check out LewRockwell.com or The Libertarian Enterprise sometime.

  • ||

    Au Standard writes:

    "general welfare" implies a schip program?!....wow what a logical leap...anyway the general welfare clause meant "general welfare" as defined by Constitutional limits...which again gives no enumerated power to create schip in the first place....nice try

    Au,

    I never said that the "general welfare" clause in the Preamble and again in Article 8, Section 1, implies an SCHIP program. I said it allows it just as it would allow the Congress to provide every American with $500 and a pony.

    The Congress gets to decide what "promoting the general welfare" means. It is no stretch for the Congress to decide that all children should be guaranteed proper health care. What could better promote the general welfare?

  • ||

    Ian,

    You are flat wrong about Congress' authority to determine what the constitution means. The Federal government is one of limited and enumerated powers. The means provided to "promote the general welfare" are enumerated by the constitution, not determined at the whim of a politician with fiduciary motives determined by bad passions.

    Your reasoning is willfully ignorant and is argued in reverse from a pre-determined conclusion.

    Popular majorities do not determine what is permissible in a constitutional republic, that in and of itself is a very dangerous proposition.

    You are FLAT WRONG on this subject.

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